SBA Form 2484 SD PPP Lender Application

Paycheck Protection Program
Lender’s Application - Second Draw Loan Guaranty
Revised March 18, 2021

OMB Control No.: 3245-0417
Expiration Date: 9/30/2021

The purpose of this form is to collect identifying information about the Lender, the Applicant, the loan guaranty request, sources and uses of funds, the
proposed structure (which includes pricing and the loan term), and compliance with SBA Loan Program Requirements. This form reflects the data fields
that will be collected electronically from lenders; no paper version of this form is required or permitted to be submitted. As used in this application,
“Paycheck Protection Program Rules” refers to the rules in effect at the time you submit this application that have been issued by the Small Business
Administration (SBA) and the Department of the Treasury implementing the Paycheck Protection Program, including Second Draw Paycheck Protection
Program Loans, under Division A, Title I of the Coronavirus Aid, Relief, Economic Security Act and Economic Aid to Hard-Hit Small Businesses,
Nonprofits, and Venues Act, and Title V of the American Rescue Plan Act of 2021.
Instructions for Lenders
All Second Draw Paycheck Protection Program (PPP) Loans are processed by all Lenders under delegated authority from SBA. This application must be
submitted and signed electronically in accordance with program requirements, and the information requested is to be retained in the Lender’s loan file.
A. Lender Information
Lender Name:

Lender Location ID:

Address:

City:

Lender Contact:
Contact Email:

Ph:

(

St:
)

-

_______________________________________________

Cell or Ext: (
Title:

Zip:
)

-

_______________________________________________

Applicant

B. Applicant Information (All Applicant Ownership information provided by the Applicant on the 2483-SD or 2483-SD-C must also be submitted
electronically)
Check One:
 Sole proprietor  Partnership  C-Corp  S-Corp  LLC  Independent contractor
 Self-employed individual  501(c)(3) nonprofit 501(c)(6) organization
 501(c)(19) veterans organization  Other 501(c) organization  Housing cooperative  Tribal business  Other
_________________________
Applicant Legal Name:
NAICS Code:
DBA or Tradename (if applicable):
Business Tax ID:
Year of Establishment (if applicable):
Number of Employees:
Applicant Street Address (no
City, State, Zip:
P.O. Box Addresses Allowed):
Applicant Primary Contact:
Phone: (
)
SBA Loan Number for First Draw PPP Loan :
Reduction in Gross Receipts of at
2020 Quarter:
Reference Quarter:
Least 25% (must provide for loans of
more than $150,000; provide for
loans of $150,000 or less ONLY if
Gross Receipts $
Gross Receipts: $
Applicant provided documentation
and lender performed good faith
review):
Complete this line only if Applicant
submitted SBA Form 2483-SD-C:

Total Gross Income (from IRS Form 1040, Schedule C, Line 7)

Tax Year Used for Gross Income

$

 2019
 2020

C. Loan Structure Information
Amount of Loan Request: $
Guarantee %:
100%
Loan Term in # of Months: 60 Payment: Deferred
Applicant must provide documentation to Lender supporting how the loan amount was calculated in accordance with the Paycheck Protection
Program Rules, and Lender must retain all such supporting documentation in Lender’s file.
Interest Rate: 1% (calculated on a non-compounding, non-adjustable basis)
D. Loan Amount Information
Average Monthly Payroll multiplied by 2.5 (or multiplied by 3.5 for NAICS 72 applicants)
If Applicant submitted SBA Form 2483-SD-C, use the amount entered in B in either table, plus the
amount entered in C for Applicants with employees (if applicable), multiplied by 2.5 (or multiplied by
3.5 for NAICS 72 applicants)
Total (may not exceed $2,000,000)

SBA Form 2484-SD (3/21)

$
$

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E. General Eligibility (If the answer is no to any, the loan cannot be approved)

• The Applicant has certified to the Lender that (1) it was in operation on February 15, 2020, has not permanently closed,

and was either an eligible self-employed individual, independent contractor, or sole proprietorship with no employees or
had employees for whom it paid salaries and payroll taxes or paid independent contractors, as reported on Form(s) 1099MISC; (2) current economic uncertainty makes this loan request necessary to support the ongoing operations of the
Applicant; (3) it received a First Draw Paycheck Protection Program Loan and, before the Second Draw PPP Loan is
disbursed, will have used the full loan amount (including any increase) of the First Draw Paycheck Protection Program
Loan only for eligible expenses; (4) the funds will be used to retain workers and maintain payroll, or make payments for
mortgage interest, rent, utilities, covered operations expenditures, covered property damage costs, covered supplier costs,
and covered worker protection expenditures.

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

• The Applicant has certified to the Lender that it has realized a reduction in gross receipts in excess of 25% relative to the

relevant comparison time period. For loans greater than $150,000 (or if the loan is $150,000 or less and the Applicant
provides documentation of revenue reduction with its application), the Applicant has provided documentation to the Lender
substantiating the decline in gross receipts and the Lender has confirmed the dollar amount and percentage of the
Applicant’s decline in gross receipts by performing a good faith review, in a reasonable time, of the Applicant’s calculations
and of the gross receipts documentation provided by the Applicant. For loans of $150,000 or less that have not provided
documentation, the Applicant has certified to the Lender that it will provide documentation substantiating the decline in
gross receipts upon or before seeking loan forgiveness or upon SBA request.

• The Applicant has certified to the Lender that the Applicant, together with its affiliates (if applicable), (1) is an independent

contractor, self-employed individual, or sole proprietor with no employees; (2) employs no more than 300 employees; (3) if
NAICS 72, employs no more than 300 employees per physical location; (4) if a news organization that is majority owned or
controlled by a NAICS code 511110 or 5151 business, a nonprofit public broadcasting entity with a trade or business under
NAICS code 511110 or 5151, or an Internet-only news or periodical publisher assigned NAICS code 519130 and engaged
in the collection and distribution of local or regional and national news and information, employs no more than 300
employees per location; or (5) if a 501(c)(3) organization, an eligible 501(c)(6) organization, other eligible 501(c)
organization, or eligible destination marketing organization, employs not more than 300 employees per physical location.

• The Applicant has certified to the Lender that (1) it has not been approved for a Shuttered Venue Operator (SVO) grant

from SBA as of the date of the loan application, and acknowledged that if the Applicant is approved for an SVO grant
before SBA issues a loan number for the loan, the Applicant is ineligible for the loan and acceptance of any loan proceeds
will be considered an unauthorized use; (2) the President, the Vice President, the head of an Executive department, or a
Member of Congress, or the spouse of such person as determined under applicable common law, does not directly or
indirectly hold a controlling interest in the Applicant, with such terms having the meanings provided in Section 322 of the
Economic Aid to Hard-Hit Small Businesses, Nonprofits, and Venues Act; (3) the Applicant is not an issuer, the securities
of which are listed on an exchange registered as a national securities exchange under section 6 of the Securities Exchange
Act of 1934 (15 U.S.C. 78f); (4) the Applicant is not a business concern or entity (a) for which an entity created in or
organized under the laws of the People’s Republic of China or the Special Administrative Region of Hong Kong, or that has
significant operations in the People’s Republic of China or the Special Administrative Region of Hong Kong, owns or
holds, directly or indirectly, not less than 20 percent of the economic interest of the business concern or entity, including as
equity shares or a capital or profit interest in a limited liability company or partnership; or (b) that retains, as a member of
the board of directors of the business concern, a person who is a resident of the People’s Republic of China; (5) the
Applicant is not required to submit a registration statement under section 2 of the Foreign Agents Registration Act of 1938
(22 U.S.C. 612); and (6) the Applicant is not a business concern or entity primarily engaged in political or lobbying
activities, including any entity that is organized for research or for engaging in advocacy in areas such as public policy or
political strategy or otherwise describes itself as a think tank in any public documents.

• The Applicant has certified to the Lender that the Applicant has not and will not receive another Second Draw Paycheck
Protection Program Loan.

F. Applicant Certification of Eligibility (If not true, the loan cannot be approved)

 True

• The Applicant has certified to the Lender that the Applicant is eligible under the Paycheck Protection Program Rules.

G. Franchise/License/Jobber/Membership or Similar Agreement (If a franchise and not listed in the SBA Franchise Directory, the loan
cannot be approved)

• The Applicant has represented to the Lender that it is a franchise.
• The Applicant has represented that the franchise is listed in SBA’s Franchise Directory.
• If Yes, enter the SBA Franchise Identifier Code here: _______________

 Yes
 Yes

 No
 No

H. Character Determination (If no, the loan cannot be approved)

• The Applicant has represented to the Lender that neither the Applicant (if an individual) nor any individual owning 20% or
•

more of the equity of the Applicant is presently incarcerated or, for any felony, presently subject to an indictment, criminal
information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction.
The Applicant has represented to the Lender that neither the Applicant (if an individual) nor any owner of the Applicant has
within the last 5 years, for any felony involving fraud, bribery, embezzlement, or a false statement in a loan application or
an application for federal financial assistance: 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; or 4)
commenced any form of parole or probation (including probation before judgment).

SBA Form 2484-SD (3/21)

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 Yes

 No

 Yes

 No

I. Prior Loss to Government/Delinquent Federal Debt (If no, the loan cannot be approved)

• The Applicant has certified to the Lender that neither the Applicant nor any owner is presently suspended, debarred,

proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal
department or agency, or presently involved in any bankruptcy.

 Yes

 No

controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency (other than a
Federal student loan made or guaranteed through a program administered by the Department of Education) that is (a)
currently delinquent or (b) has defaulted in the last 7 years and caused a loss to the government.

 Yes

 No

 Yes

 No

• The Applicant has certified to the Lender that neither the Applicant nor any of its owners, nor any business owned or

J. U.S. Employees (If no, the loan cannot be approved)

• The Applicant has certified that the principal place of residence for all employees included in the Applicant’s payroll
calculation is the United States.

K. Fees (If yes, Lender may not pass any agent fee through to the Applicant or offset or pay the fee with the proceeds of this loan)

• Has the Lender directly contracted with a third party to assist in the preparation of the loan application or application
materials, or to perform other services in connection with this loan?

 Yes

 No

SBA Certification to Financial Institution under Right to Financial Privacy Act (12 U.S.C. 3401)
By signing SBA Form 2483-SD or 2483-SD-C, Borrower Application Form in connection with this application for an SBA-guaranteed loan, the
Applicant certifies that it has read the Statements Required by Law and Executive Orders, which is attached to SBA Form 2483-SD or 2483-SD-C. As
such, SBA certifies that it has complied with the applicable provisions of the Right to Financial Privacy Act of 1978 (12 U.S.C. 3401) and, pursuant to
that Act, no further certification is required for subsequent access by SBA to financial records of the Applicant/Borrower during the term of the loan
guaranty.

Lender Certification
On behalf of the Lender, I certify that:
The Lender has complied with the applicable lender obligations set forth in paragraphs (h)(2)(i)(A)-(D) of the interim final rule “Paycheck
Protection Program Second Draw Loans” (issued on January 6, 2021), and any amendments thereto.
•
The Lender has obtained and reviewed the required application (including documents demonstrating qualifying payroll amounts and, if required,
qualifying gross receipts reduction) of the Applicant and will retain copies of such documents in the Applicant’s loan file.
•
The Lender will register in sam.gov no later than thirty (30) days from the date of the first disbursement of a First Draw PPP Loan or Second Draw
PPP Loan made by the Lender after January 7, 2021 and will provide SBA with the Lender’s unique entity identifier.
I certify that:
•

•

Neither the undersigned Authorized Lender Official, nor such individual’s spouse or children, has a financial interest in the Applicant.
Authorized Lender Official:

Date:

Signature

Type or Print Name:

Title:

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currently valid
OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, and completing
and reviewing the form is 25 minutes per response. Comments or questions on the burden estimates should be sent to U.S. Small Business
Administration, Director, Records Management Division, 409 3rd St., SW, Washington DC 20416, and/or SBA Desk Officer, Office of Management and
Budget, New Executive Office Building, Rm. 10202, Washington DC 20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 2484-SD (3/21)

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